The Waldegrave Trust
Nelson Primary School
Application Form /
Post applied for: / Return completed form to:
Email:
Post:
Headteacher
Nelson Primary School
Nelson Road
Whitton
Twickenham TW2 7BU
Personal Details
Title / Please selectMissMsMrsMrDr
First Names:
Last Name: / Previous last names used:
Address and post code:
Email address:
Telephone Numbers: / Home
Mobile
Work
Nationality:
National Insurance Number:
Are there any restrictions on your right to work in the UK? / Yes
No / If yes, please give details:
For teaching posts only:
Qualified Teacher Status / Qualified in UK Currently Training
Qualified overseas Not qualified
Teacher Registration Number
Present or most recent job – please explain any gaps in your employment history
Name of Employer
Address of Employer
Telephone Number
Date of appointment
Currently employed / Yes No
If no, provide leaving date
If yes, notice required
Reason for leaving
Post held:
Salary:
Scale / TLR/ Grade
Short description of post held:
Previous employment (latest first) - please explain any gaps in your employment history
Employer / Post held
and grade if appropriate / Dates
From /To / Reason for Leaving
Education / Qualifications
Higher Education And Professional Qualifications
Name of College / University / Qualification and Subject(s) / Grade / Class
(if applicable) / Date
Post 16 Qualifications e.g.A Level or equivalent
Name of school / college / Subject / Qualifications / Grade / Date
GCSE – please confirm that you hold a GCSE / O-level or equivalent in Maths and English
Name of school / college / Subject / Qualifications / Grade / Date
Other Qualifications / membership of professional institutes
Professional Development
Relevant courses attended in the last 3 years
Date / Title of course / Duration
Personal Statement
Please write a supporting statement of not more than two pages which should address the selection criteria for this post. Any information included separately (e.g. in a covering email or a CV) will not be seen by the selection panel.
References
Please give the name and address of two people who can provide a reference for you. The first referee must be your current employer and if this is a school, this must be the headteacher. If you are/ were working with children, your present and former employers will be asked about safeguarding concerns. Please do not give friends or relatives as referees. If you are selected for interview we will contact your referees prior to interview.
Name: / Name:
Job Title: / Job Title:
Capacity in which known to you: / Capacity in which known to you:
Organisation: / Organisation:
Address: / Address:
Telephone No: / Telephone No:
E-mail address: / E-mail address:
Criminal Record
All staff appointed will be asked to undergo a Disclosure and Barring Service check and Children’s Barred List check.This post is exempt from the Rehabilitation of Offenders Act 1974. You are required to declare any convictions, cautions and bind-overs you may have, regardless of how long ago they occurred, including those regarded as ‘spent’. Having a criminal record will not necessarily prevent you from taking up appointment; this will depend on the nature of the offences and their relevance to the post you are applying for. However, should you not declare an offence that is subsequently revealed, e.g. through the DBS check, then this may place your appointment in jeopardy.
Have you ever been convicted of a criminal offence, cautioned or bound-over? / Yes No
If your answer is Yes, please send separate details in a sealed envelope marked “Confidential” addressed to the headteacher if you are invited to interview.
Disability
The school welcomes applications from disabled people. Please indicate in the box below if there is anything that we need to do, or take into consideration, to ensure that the shortlisting process is fair in relation to a disability.
Candidates who are invited for interview will be asked in the invitation letter if they require any adjustments to be made to the interview or other selection activities.
Declaration
I declare that the information given in this form and any other accompanying documents is true and correct and I understand that any omissions or false statements on this form may justify my dismissal. I understand that the information I have given on this form may be held and processed by the school in accordance with the Data Protection Act 1998.

…………………………………………………………………..…………………………………

Applicant’s signature (If you submit online we will ask you to sign a hard copy later)Date

Monitoring Information
This page is removed from the application form prior to shortlisting and interview. The information on this page will be used to produce the school’s recruitment and selection monitoring reports.
Gender /
Age Group
Female / 16-17
Male / 18-20
Religion
/ 21-24
Buddist / 25-30
Christian / 31-49
Hindu / 50-64
Jewish / 65+
Muslim /
I consider myself to have a disability
Sikh / Yes
None / No
Other (Please Specify) /
Ethnic Origin
Please tick one box in this section
White / British / Mixed / White & Black Caribbean
Irish / White & Black African
Other specify below / White & Asian
Other specify below
Asian or
/ Indian /
Black or
/ Caribbean
Asian British
/ Pakistani /
Black British
/ African
Bangladeshi / British
Asian British / Other specify below
Other specify below
Chinese or / Chinese
Other / Vietnamese
Middle Eastern
Other specify below
Job Advertisement: I heard about this job through:
Nelson Primary School Website
E-teach
Other (please describe)

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